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Effect of Cardiac Surgery Availability and Institutional Procedural Volume on Clinical Outcomes Following Complex,
Wayne C Zheng1, Sara Vogrin2, Jiwon Kim3
1Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia.
Insights
Outcomes for complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) were similar regardless of hospital cardiac surgery availability or CHIP-PCI volume. High adverse event rates highlight the need for further research on revascularization appropriateness.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Services Research
Background:
- Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) is increasingly common.
- Outcomes and definitions for CHIP-PCI vary, necessitating further investigation.
Purpose of the Study:
- To evaluate the impact of cardiac surgery availability on CHIP-PCI outcomes.
- To assess the relationship between CHIP-PCI procedural volume and patient outcomes.
- To analyze 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality.
Main Methods:
- Analysis of a multicenter PCI registry in Victoria, Australia (2014-2021).
- CHIP-PCI defined by a composite risk score (≥5 points) incorporating multiple prognostic factors.
- Stratification of hospitals by cardiac surgery availability and CHIP-PCI annual volume tertiles (<16, 16-36, >36 cases).
Main Results:
- A total of 6,476 CHIP-PCI procedures were identified (7.0% of all PCIs), with a mean age of 82 years and high comorbidity burden.
- 30-day MACCE and 5-year mortality rates were 13% and 36%, respectively.
- No significant differences in 30-day MACCE or long-term mortality were observed based on cardiac surgery availability or CHIP-PCI volume tertiles.
Conclusions:
- CHIP-PCI outcomes are comparable across different institutional volumes and the presence of cardiac surgery services.
- The high rates of adverse outcomes in CHIP-PCI patients emphasize the critical need to refine criteria for revascularization appropriateness.
- Further research is essential to optimize patient selection and management for CHIP-PCI procedures.
Background:
Complex, high-risk, and indicated (CHIP) percutaneous coronary intervention (PCI) is increasingly performed with variable reported outcomes and consensus on definition.
Aims:
We evaluated the relationship between cardiac surgery availability and CHIP-PCI volume (stratified into tertiles < 16, 16‒36, > 36 annual cases) at treating hospitals with 30-day major adverse cardiac and cerebrovascular events (MACCE) and long-term mortality.
Methods:
All procedures (2014‒2021) captured by a multicenter PCI registry (Victoria, Australia) were analyzed. CHIP-PCI was defined by composite risk score of ≥ 5 points, with prognostic factors assigned three points (e.g., mechanical circulatory support), two points (e.g., age ≥ 80, peripheral vascular disease, severe left ventricular dysfunction, renal impairment) and one point (female, previous stroke, left main/three-vessel PCI, total stent length > 60 mm, rotational atherectomy).
Results:
Of 91,961 procedures, 6476 (7.0%) were CHIP-PCI (mean age 82 years; 66% females). CHIP-PCI group had high burden of comorbidities including diabetes (26%), renal impairment (93%), and prior coronary bypass surgery (11%). CHIP-PCI was performed for STEMI (21%), non-STEMI (26%) and nonacute coronary syndrome (47%) indications. Overall, 30-day MACCE and 5-year mortality were 13% and 36% respectively. There was no difference in 30-day MACCE and long-term mortality among CHIP-PCI patients treated at cardiac surgical centers versus Nonsurgical centers (all p > 0.05). Likewise, there was no association between tertiles of annual CHIP-PCI volume with 30-day MACCE and long-term mortality (all p > 0.05).
Conclusions:
In contemporary practice, CHIP-PCI outcomes appear similar across institutional CHIP-PCI volume tertiles and availability of cardiac surgery. High rates of adverse outcomes underscore the need for further research regarding revascularization appropriateness.
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